Disease and Condition

Parkinson's Disease
What is it?Parkinson's disease is a progressive, degenerative disorder of the nervous system, meaning it becomes increasingly disabling over time. People with Parkinson's disease have rigid muscles, sluggish movements, and tremors (shaking). Parkinson's disease is chronic, meaning it is a life-long condition.

Who gets it?
Parkinson's disease is one of the most common diseases affecting movement in people over the age of 55. It affects approximately 1 in every 250 people over the age of 40, and around 1 in every 100 people over the age of 65. There are as many as 50,000 new cases each year. Of people with Parkinson's disease, symptoms are evident in up to 15% of those between the ages 65 and 74, and almost 30% of those between the ages 75 and 84.

What causes it?
There is an area deep in the brain called the basal ganglia. Nerve cells in the basal ganglia are responsible for smooth movements and coordinating changes in posture. When the brain initiates a movement, the basal ganglia sends signals and transmits messages using chemical neurotransmitters. These neurotransmitters are like electrical impulses sent over electrical wires, but in this case these electrical impulses are sent along nerve pathways within the brain. The main neurotransmitter for the basal ganglia is dopamine. No one is exactly sure why, but Parkinson's disease occurs when the nerve cells in the basal ganglia begin to die. When this happens, the amount of dopamine produced is lowered, and the signals that control muscle movement are weak or lost. The patient slowly loses the ability to control the initiation, speed, and smoothness of his or her movements. In the later stages of the disease, 80% or more of the nerve cells are dead or damaged. While the cause is not truly known, researchers believe that these nerve cells can die or become damaged by infection; trauma; toxins found in the environment; a chemical called MPTP, which is found some illegal drugs; or by some drugs used to treat psychosis, including haloperidol or chlorpromazine. While the disease does tend to occur in some families, no definite genetic link has been identified.

What are the symptoms?
Parkinson's disease is progressive, so the symptoms keep getting worse over time. The disease begins with very subtle signs. The patient may notice a slight shaking, called tremor, in his or her hand when it is at rest. He or she may rub the thumb and forefinger together repeatedly, as though rolling a small object between them. Moving the hand, or sleeping, makes the tremor go away. Tremor may eventually affect the other hand, arms, legs, head, jaw, tongue, and eyelids. Fatigue or stress may increase the tremor. As the disease progresses, it becomes difficult to initiate movement, and the muscles become stiff, making movement jerky. The slowed movement that is a symptom of Parkinson's disease is called bradykinesia. The patient may also freeze in the middle of a movement, called akinesia. People with Parkinson's may have difficulty writing, speaking, changing positions, and maitaining balance. Because the facial muscles also become rigid, people with Parkinson's disease may look expressionless, as though their face is a mask. As the disease progresses, the mouth may hang open, and the patient may drool or choke because the muscle stiffness progresses to the throat and makes swallowing difficult. Other symptoms include abdominal cramps, rapid speech with little expression in the voice, problems with sleeping, the inability to control the flow of urine (incontinence), and constipation. In the later stages, many people with Parkinson's disease suffer from depression and develop dementia, which is the progressive loss of intellectual function, and psychosis, a loss of an awareness of reality.

How is it diagnosed?
If you suspect you have early symptoms of Parkinson's disease, your doctor will take a complete medical history and perform a thorough physical exam. He or she will check for the physical signs Parkinson's, including tremor, rigid muscles, and slow movements. While there is no specific diagnostic test for Parkinson's disease, there are some tests your doctor may perform to rule out other diseases that can cause similar symptoms. These might include brain scans, blood tests, a lumbar puncture to check spinal fluid for signs of bacterial infections, and x-rays.

What is the treatment?
At this time, there is no cure for Parkinson's disease. However, with proper treatment, people with Parkinson's can lead a full and productive life. If you have mild Parkinson's symptoms, your doctor may not prescribe any medication, but will schedule regular check-ups so that he or she is aware of any change in your symptoms and can prescribe the appropriate treatment.

There are several different drugs available to treat Parkinson's disease. None of these will cure the disease or stop the progression of symptoms, but they can help with movement and keep you functioning as close to normal as possible. Medications commonly prescribed include levodopa, which helps the brain make dopamine; bromocriptine and pergolide, also dopamine-like drugs; selegiline, a drug that slows the breakdown of dopamine; amantadine, which is also used to treat flu, but has mild anti-Parkinsonian effects; and anticholinergic drugs, such as benztropine, trihexyphenidyl, orphenadrine, certain antidepressants, and antihistamines. Anticholinergic drugs block the neurotransmitter acetycholine from causing smooth muscle contraction. Dopamine and acetycholine often counteract each other in the brain. Most of these drugs are prescribed with levodopa, also called L-dopa. Levodopa is probably the most well known of all anti-Parkinson drugs. It is very effective at reducing tremor and rigidity of the muscles. However, it does have a number of potential side effects, including involuntary movement of the face, mouth, and limbs; short-term memory loss; nausea and vomiting; and confusion. Levodopa is often given in combination with carbidopa or benzaseride to increase the drug's effectiveness and decrease any unwanted effects outside the brain. Levodopa is not recommended for people with closed-angle glaucoma. After several years of levodopa treatment, most patients find that its periods of effectiveness become shorter. They also begin to experience what's known as the Òoff-on effect,Ó where the patient is okay one minute, then suddenly unable to move. These types of symptoms can be controlled by taking a lower dose of levodopa more frequently. Patients with Parkinson's disease should follow a regular daily exercise program to help maintain muscle use. A physical therapist can help design an effective exercise program that takes into consideration your special needs. Good nurtrition is also important. If chewing and swallowing are difficult, you may need to adopt a softer diet. If constipation is a problem, your doctor will recommend an increase in fiber. Many patients with Parkinson's have delayed gastric emptying, which results in a feeling of fullness without eating much. This condition can be treated with a drug called cisapride. Because the amount of protein in your diet can have an effect on the absorption of levodopa, your doctor or nutritionist may recommend a diet slightly lower in proteins. Always consult your doctor about any dietary changes.

Surgery for Parkinson's disease is only recommended when all other treatments have failed. One surgical procedure called pallidotomy involves destroying part of a small structure within the brain called the globus pallidus internus. The globus pallidus internus is a portion of the brain that affects movement, so this surgery may reduce tremors, but have negative side effects on balance and coordination. Another technique for controlling severe tremor involves using mild electrical pulses to stimulate the brain. A surgeon implants an electrode in the area of the brain where nerve impulses are relayed and movement is generated. A wire from the electrode follows a path under the skin from the skull to a small generator implanted in the chest. The patient turns on the generator with a hand-held magnet to deliver an electronic pulse to the brain, which blocks the brain signals that trigger tremor. This treatment is not effective for everyone, so it is important to discuss this option thoroughly with your doctor. Stem cell transplantation, in which fetal tissue is implanted in a patient's brain to replace malfunctioning nerves, is an ongoing source of controversial research but has shown some promise in treating conditions such as Parkinson's disease. Some patients also find relief from alternative treatments such as acupuncture, massage, and yoga. Botulinum toxin A is an alternative treatment that has been found effective in treating head, hand, and voice tremors. Botulinum is a bacterium that causes food poisoning (botulism), but causes the muscles to relax when used in a weak solution. Consult with your doctor before trying any alternative treatments such as botulinum toxin, vitamin therapy, or herbal therapy, because they can have adverse side effects or interfere with the action of levodopa.

Self-care tips
While there is no known way to prevent Parkinson's disease, you can relieve your symptoms and live a full life by following your doctor's recommended treatment plan. You can also make adjustments in your home to reduce your chances of falling. For example, install handrails in areas such as hallways and shower stalls, and around the toilet seat. If swallowing is a problem, give yourself plenty of time to eat and adjust your diet so it is easier to eat. Be extremely careful when handling hot liquids. It is extremely important to stay active, to keep your mind and body as fit as possible.
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