Overview

 

Parkinson's Disease

Parkinson's disease is a chronic, progressive neurodegenerative movement disorder. Tremors, rigidity, slow movement (bradykinesia), poor balance, and difficulty walking (called parkinsonian gait) are characteristic primary symptoms of Parkinson's disease.

Idiopathic Parkinson's disease is the most common form of parkinsonism, which is a group of movement disorders that have similar features and symptoms. Parkinson's disease also is called idiopathic Parkinson's because the cause for the condition is unknown. In the other forms of parkinsonism, a cause is known or suspected.

Parkinson's disease may include


As symptoms get worse, people with the disease may have trouble walking, talking or doing simple tasks. They may also have problems such as depression, sleep problems or trouble chewing, swallowing or speaking.

Parkinson's usually begins around age 60, but it can start earlier. It is more common in men than in women. There is no cure for Parkinson's disease. A variety of medicines sometimes help symptoms dramatically.

Symptoms

The disorder may affect one or both sides of the body. How much function is lost can vary.

Symptoms may be mild at first. For instance, the patient may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging.

Primary Symptoms

Bradykinesia is slowness in voluntary movement. It produces difficulty initiating movement, as well as difficulty completing movement once it is in progress. The delayed transmission of signals from the brain to the skeletal muscles, due to diminished dopamine, produces bradykinesia. Bradykinesia and rigidity that affects the facial muscles can result in an expressionless, "mask-like" appearance.

Tremors in the hands, fingers, forearm, or foot tend to occur when the limb is at rest, but not when the patient is performing tasks. Tremor may occur in the mouth and chin as well.

Rigidity, or stiff muscles, may produce muscle pain and facial masking. Rigidity tends to increase during movement.

Poor balance is due to the impairment or loss of the reflexes that adjust posture in order to maintain balance. Falls are common in people with Parkinson's disease.

Parkinsonian gait is the distinctive unsteady walk associated with Parkinson's disease. There is a tendency to lean unnaturally backward or forward, and to develop a stooped, head-down, shoulders-drooped stance. Arm swing is diminished or absent and people with Parkinson's tend to take small shuffling steps (called festination). Patient's with Parkinson's may have trouble starting to walk, may appear to be falling forward as they walk, may freeze in mid-stride, and may have difficulty making a turn.

Secondary Symptoms

The progressive loss of voluntary and involuntary muscle control produces a number of secondary symptoms associated with Parkinson's. Most patients do not experience all of them, and symptoms vary in intensity from person to person.

Some secondary symptoms of Parkinson's disease include the following: -

Medical Treatment

There is no cure for Parkinson's disease. Treatment centers on the administration of medication to relieve symptoms. The Food and Drug Administration (FDA) also has approved a surgically-implanted device that lessens tremors. In some severe cases, a surgical procedure may offer the greatest benefit.

Medication

Medication selection and dosage is tailored to each individual patient. In deciding on a treatment, the physician considers factors such as severity of symptoms, age, and presence of other medical conditions. No two patients respond identically to a particular drug or dosage level, so this process involves experimentation, persistence, and patience.

As Parkinson's disease progresses, drug dosages may have to be modified and medication regimens changed. Sometimes a combination of drugs is given.

Levodopa and carbidopa combined (Sinemet®) is the mainstay of Parkinson's therapy. Levodopa is rapidly converted into dopamine by the enzyme dopa decarboxylase (DDC), which is present in the central and peripheral nervous systems. Much of levodopa is metabolized before it reaches the brain.

Carbidopa blocks the metabolism of levodopa in the liver, decreasing nausea and increasing the amount of levodopa that reaches the brain. Levodopa is most effective in treating bradykinesia and rigidity, less effective in reducing tremor, and often ineffective in relieving problems with balance.

Side effects include nausea, especially early in treatment, low blood pressure (hypotension), and abnormal movements (dyskinesias). Slow dosage adjustment and taking medication with food can reduce these effects and using the lowest effective dose may prevent or delay the appearance of motor dysfunction. Levodopa can become ineffective over time.

Surgery

Surgery may be used to control symptoms of Parkinson's disease and improve the quality of life when medication ceases to be effective or when medication side effects, such as jerking and dyskinesias, become intolerable.Not every Parkinson's patient is a good candidate for surgery. For example, if a patient never responded to, or responded poorly to levodopa/carbidopa, surgery may not be effective. Only about 10% of Parkinson's patients are estimated to be suitable candidates for surgery.

Every surgical procedure carries inherent risks. Parkinson's patients who are suitable for surgery may forgo the procedure if they feel these risks outweigh the potential benefits. In some cases, Parkinson's symptoms do not improve or worsen following the operation.

There are three surgical procedures for treating Parkinson's disease: ablative surgery, stimulation surgery or deep brain stimulation (DBS), and transplantation or restorative surgery.

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