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Today in Health & Wellness
HEALTH CONDITIONS

Parkinson's Disease

Overview
Symptoms
Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Doctors to Consult
Overview

Common name/Other name

Parkinson’s (Eng.)

Parkinson’s disease (PD) is a progressive neurodegenerative disorder of the brain. PD causes neurons in several parts of the brain to degenerate resulting in a decrease of dopamine release. It leads to an imbalance in the levels of the neurotransmitters in the brain – low dopamine, high acetylcholine. Thiscauses most of the characteristic symptoms of PD collectively termed Parkinsonism. The disease progression is classified into 5 stages with increasing severity of symptoms.

Stages of Parkinson’s Disease:

  • Stage 1 manifests with tremors and difficulties in movement. There are changes in posture, walk, and facial expressions.
  • Stage 2 produces moderate symptoms with more noticeable stiffness, tremors, and trembling. Difficulties in walking progress but balance is still normal.
  • Stage 3 already causes a patient to lose balance and have decreased reflexes. Frequent falls are common in this stage. Daily activities are greatly affected because movements are significantly slower.
  • Stage 4 PD patients stand without help from another person but require the use of assistive devices such as a walker. Patients already need help for daily tasks since living alone can be dangerous.
  • Stage 5 inhibits the patient from standing or walking due to advanced muscle stiffness. Patients heavily require assistance. Hallucinations and delusions are common.

The exact cause of PD is still unknown, but several contributing factors have been identified. Some gene mutations can cause PD especially in a family with many members who have Parkinson’s. Certain toxins and environmental triggers also increase the risk of PD. Within the brain cells of PD patients, Lewy bodies or clumps of specific substances like A-synuclein are present.

There are no specific tests to diagnose PD. Physicians use the patient’s symptoms, medical history and results of various tests to conclude its presence. Neurological and physical exams are done as well as imaging tests of the brain to eliminate other disorders of the brain. Significant improvement of symptoms upon the use of carbidopa-levodopa can also confirm PD.

 

Symptoms
  • Resting tremor or involuntary shaking of a limb, usually the fingers or hands
  • Pill-rolling tremor or the rubbing of thumb and forefinger
  • Bradykinesia or slow movement due to reduced ability to move
  • Muscle rigidity or stiffness
  • Hypokinesia or a decrease in the range of motion
  • Flexed or stooped posture
  • Balance problems
  • Decreased unconscious movements like blinking, smiling, and swinging of arms when walking
  • Speech problems
  • Changes in handwriting
Risk Factors
  • Age. Risk increases with age and commonly develops around 60 years old
  • Heredity. Higher risk when there are several family members who have PD
  • Sex. Men are at increased risk
  • Exposure to toxins. Constant contact with pesticides and herbicides
Commonly Prescribed Drugs

There are no current medications that cure PD. Parkinson’s drugs are used to control the symptoms of a patient. The goal of drug therapy is to increase or replace dopamine in the brain to improve the symptoms.

  • Carbidopa-levodopa is the most common and effective drug combination for PD. Levodopa enters the brain and converts into dopamine which effectively increases the dopamine levels. Carbidopa protects levodopa from converting into dopamine outside the brain. However, levodopa does not have an effect on the disease progression and its effect decreases with time. High doses of levodopa promote dyskinesia or involuntary movements. Side effects: nausea, lightheadedness especially upon standing
  • Dopamine agonists imitate the effects of dopamine in the brain. These are less effective than levodopa but can be used as a supplement to manage the wearing off of levodopa’s effects. Examples of dopamine agonists include pramipexole, ropinirole, and rotigotine. Side effects: lightheadedness, hallucinations, sleepiness, compulsive behaviors
  • MAO-B inhibitors increase the levels of dopamine by inhibiting monoamine oxidase B which metabolizes it. These drugs can decrease the progression of PD. Rasagiline and selegiline are the available MAO-B inhibitors. Side effects: nausea, insomnia
  • COMT inhibitors prolong the effects of levodopa by inhibiting another enzyme that breaks down dopamine, the catechol-O-methyltransferase. Entacapone is the main COMT inhibitor used. Side effects: dyskinesias, diarrhea
  • Anticholinergics control resting tremor which is the primary symptom of PD. These drugs inhibit the effects of acetylcholine which causes some of PD symptoms. Examples of anticholinergics for PD include benztropine and trihexyphenidyl. Side effects: impaired memory, confusion, hallucinations, constipation, dry mouth, difficulty urinating
  • Amantadine is usually given alone during mild, early stages of PD for a quick relief of symptoms. It is given during the later stages of PD in combination with carbidopa-levodopa. Side effects: purple mottling of skin, ankle swelling, hallucinations
Treatment and Management
  • Healthy eating especially increasing the intake of fiber and amount of fluids help manage some symptoms such as constipation.
  • Regular exercise increases muscle strength and balance. This also manages depression and anxiety common in PD patients.
  • Rehabilitation therapies help PD patients manage symptoms and do daily activities easily. An occupational therapist can educate the patient in doing tasks such as dressing, bathing, eating, and writing.

 

Complications

  • Cognitive problems that can progress to dementia
  • PD patients are more prone to depression and emotional changes such as fear, anxiety, and loss of motivation
  • Swallowing becomes difficult and saliva collects in the mouth leading to drooling
  • Sleep disorders such as frequent waking at night, waking up early or falling asleep during the day
  • Urinating may be difficult or uncontrolled. Bowel movements become hard.

 

Surgery

  • Deep brain stimulation (DBS) uses electrodes to inactivate parts of the brain that cause PD symptoms. Electrical impulses are sent to the brain to block the abnormal impulses.
  • Pallidotomy targets the part of the brain that is overactive. The permanent destruction of the overactive part lessens the symptoms of PD such as tremors, bradykinesia, and balance problems.
  • Thalamotomy destroys a part of the brain to inhibit abnormal brain activity that causes tremors.
  • Gamma knife treatment is beneficial for patients who cannot undergo an invasive surgical procedure. Gamma radiation beams target the affected area of the brain to reduce the symptoms of PD.
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Doctors to Consult
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