Parkinson

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Parkinson's Disease
Definition
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
Causes
The symptoms of Parkinson's disease are caused by a loss of nerve cells in a part of the brain called the substantia nigra, resulting in a decrease in dopamine (a neurochemical) throughout the brain. This destruction occurs due to genetic, environmental, or a combination of both causes. The resulting lack of dopamine results in the symptoms associated with Parkinson’s disease.
Secondary parkinsonism is a condition with similar symptoms, but symptoms can be traced to several causes, including:
• Antipsychotic drugs, such as haloperidol (Haldol), fluphenazine (Prolixin), trifluoperazine (Stelazine), and chlorpromazine (Thorazine)
• Carbon monoxide poisoning
• Manganese poisoning
• Hydrocephalus
• Brain tumors
• Stroke
• Encephalitis
• Meningitis
• IV drug abuse of MPTP
• Reserpine
• Insecticide exposure
• Trauma
• AIDS
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
• Age: 50 or older
• Gender: Men are slightly more likely than women to develop Parkinson's disease.
• Family members with Parkinson's disease
• Nonsmokers
• Exposure to toxins, drugs, or conditions specified above
Symptoms
Symptoms of Parkinson's disease begin mildly and progressively 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 (abnormally increased secretion and discharge of sebum producing an oily appearance of the skin and the formation of greasy 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
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam. There are no tests to definitively diagnose Parkinson's disease. The doctor will ask many questions to rule out other causes of your symptoms.
Tests to rule out other medical conditions may include:
• Blood tests
• Urine tests
• CT, MRI, or PET (positron emission tomography) scans of the head
Treatment
Currently there are no treatments to cure Parkinson's disease or proven treatments to slow or stop its progression. A number of medications are used to improve symptoms. Over time, however, their side effects may become troublesome and they may begin to lose their effectiveness.
Medications
Medications include:
• Levodopa/carbidopa (Sinemet)
• Amantadine (Symmetrel)
• Anticholinergics: benztropine (Cogentin) and biperidin (Akineton)
• Selegiline (Eldepryl)
• Dopamine agonists: bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex), cabergoline (Dostinex), and ropinirole (Requip)
o Pergolide (Permax) was withdrawn from the market in March 2007 due to the risk of serious heart valve damage; cabergoline (Dostinex) has also been associated with a similar risk.*
• Apomorphine (Apokyn)
• COMT inhibitors: entacapone (Comtan) and tolcapone (Tasmar))
Surgery
A number of brain operations are available, and many more are being researched including:
• Destroying certain areas of the brain (thalamotomy and pallidotomy)—to improve tremor in patients for whom medication is not effective
• Deep brain stimulation—implanting a device to stimulate certain parts of the brain to decrease tremor and rigidity
• Nerve-cell transplants (research only)—to increase dopamine production within the brain
Physical Therapy
Physical therapy, exercise, and stretching can improve muscle tone, strength, and balance.
Psychological Support
Joining a support group with other people who are learning to live with the challenges of Parkinson's disease can be very helpful.
Prevention
There are no guidelines for preventing Parkinson's disease.