Parkinson's Disease
Parkinson Disease is a chronic progressive disease of the central nervous system that primarily affects a person's physical movement. People with Parkinson Disease demonstrate a characteristic tremor and difficultly starting movements.
Contents |
Other Names
Symptoms
Afflicting about one million people in the US, Parkinson’s Disease (PD) is the most common nervous system degenerative disease affecting movement. There are three main features to this illness: 1) A tremor at rest 2) slowed movements (Bradykinesia) and 3) muscle rigidity. The tremor generally begins in one hand, has a quality that looks like “pill-rolling,” and disappears with active movement. Gradually, the tremor moves upward, worsens and involves the leg on the same side, followed by tremor appearing on the opposite side. Other specific signals of the disease include a shuffling walk with decreased arm swinging, lack of expression in the face, stooped posture and a change to small, irregular handwriting. In addition to difficulties with movements, further problems can occur as well. These might include problems with swallowing, loss of balance, sleep, sense of smell or mood changes, such as depression and anxiety.
Image:Parkinsonsposture.jpg|thumb|Sir William Richard Gowers, neurologist, researcher and artist, drew this illustration in 1886 as part of his documentation of Parkinson's Disease. The image appeared in his book, A Manual of Diseases of the Nervous System, still used today by medical professionals as a primary reference for this disease.
PD usually affects people over the age of fifty, although it can appear earlier in life. Early symptoms of PD may be subtle and develop gradually. In some people the disease progresses more quickly than in others. As the disease worsens progresses, the tremor, which affects the majority of PD patients, may begin to and stiffness interfere with daily activities. Other symptoms include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.
Causes
In most cases, no cause is found for PD. There are genetic factors involved in a small The underlying defect in PD is less production of the neurochemical, Dopamine, by certain brain cells of the Substantia Nigra. Treatment involves drugs aimed at restoring Dopamine. When Dopamine is lacking, the chain of events that leads to normal motor movement of the body is broken.
Diagnosis
There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD. Therefore the diagnosis is based on medical history and a neurological examination. The disease can be difficult to diagnose in the early stages. Doctors may request brain scans to determine brain activity and function, such as MRI, CAT or even PET scans and laboratory tests in order to rule out other diseases.
Treatment
At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms. Usually, patients are given levodopa combined with carbidopa. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may only be marginally reduced. Problems with balance and other symptoms may not be alleviated at all. Anticholinergics may help control tremor and rigidity. Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain. This causes the neurons to react as they would to dopamine. An antiviral drug, amantadine, also appears to reduce symptoms. In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD. Many of the drugs used for treatment can have bad side effects, so being informed and in contact with a physician is very important. consulting with a doctor or pharmacist can be helpful.[1]
In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effects of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.
Therapies
Throughout the progression of Parkinson's Disease physical therapy and specific exercise may be recommended to help adjust with functional changes. For many years, exercise and therapy has been prescribed to help improve flexibility, decrease rigidity, and improve gait and balance.[2][3]
There is also evidence that exercise and therapy can benefit the other symptoms and problems associated with PD like depression, constipation, and gait abnormalities. [4]
Cures
There is no known cure for Parkinson's Disease at this time.
Living with Parkinson's Disease
PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some patients, while for others tremor is only a minor complaint and other symptoms are more troublesome. No one can predict which symptoms will affect an individual patient, and the intensity of the symptoms also varies from person to person.
Lifestyle changes
Life with PD is quite varied between different people. However, there will be a gradual progression downward. As the disease progresses, daily activities will get more difficult and people may require assistance from family members or friends. Most people with PD will eventually require the use of canes, walkers, or even wheelchairs.
Most are diagnosed with PD in the 5th to 6th decade of life, and still have many years ahead. This can pose a problem for many due to the economical factors. As the disease progresses many cannot work any longer. Medications can be costly as can equipment and changes made to the home for adaptibility. Some may even require more medical attention such as being placed in a care facility.
Due to the changes in mobility and walking, there is greater risk of falls and personal injury.
Chances of Developing Parkinson's Disease
PD affects approximately 500,000 adults in the US. It becomes more common with increasing age.
Risk factors
Exposure to many different substances are thought to be possible risks:
- Carbon Monoxide
- Manganese
- Cyanide
- MPTP
- Pesticides and Herbicides
Related Problems
Parkinsonism incorporates many degenerative disorders that can present much like Parkinson's Disease, but have different causes:
- Striatonigral Degeneration
- Sporadic Olivopontocerebellar Atrophy
- Shy-Drager Syndrome
- Progressive Supranuclear Palsy
- Corticobasal Degeneration
- Vascular Parkinsonism
- Dementia with Lewy Bodies
Research
The National Institute of Neurological Disorders and Stroke (NINDS) conducts PD research in laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country. For information on current research use the following link:
Clinical Trials
There are many clinical trials being done on Parkinson's Disease. They range from the use of drugs aimed at increasing dopamine levels in the brain, to exercise, life adjustment, and more. There are studies throughout the US and internationally.
Select this link to view a list of studies currently seeking patients.
References
- ↑ Marsden CD. Problems with long-term levodopa therapy for Parkinson's Disease. Clin Neuropharmacol. 1994;17 Suppl 2:S32-44.
- ↑ Schenkman M, Cutson TM, Kuchibhatla M et al. Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial. J Am Geriatr Soc. 1998 Oct;46(10):1207-16. Abstract
- ↑ de Goede CJ, Keus SH, Kwakkel G et al. The effects of physical therapy in Parkinson's disease: a research synthesis. Arch Phys Med Rehabil. 2001 Apr;82(4):509-15. Abstract
- ↑ Bridgewater KJ, Sharpe MH. Aerobic Exercise and Early Parkinson's Disease. Neurorehabilitation and Neural Repair. 1996; Vol 10 No. 4: 233-241. Abstract
To suggest changes to this page, you must create an account on Medpedia.