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Parkinson's Disease

Overview

Symptoms

Causes

Treatment

Parkinson's disease belongs to a group of conditions called movement disorders. The four main symptoms are tremor, or trembling in hands, arms, legs, jaw, or head; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance. These symptoms usually begin gradually and worsen with time. As they become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has Parkinson's Disease, as the symptoms sometimes appear in other diseases as well.
 Paralysis Syndrome
 

 

Parkinson's Disease is Chronic and Progressive

Parkinson's Disease is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time. It is not contagious. Although some Parkinson's Disease cases appear to be hereditary, and a few can be traced to specific genetic mutations, most cases are sporadic — that is, the disease does not seem to run in families. Many researchers now believe that Parkinson's Disease results from a combination of genetic susceptibility and exposure to one or more environmental factors that trigger the disease.

Parkinson's Disease is the most common form of parkinsonism,

Parkinson's Disease is the most common form of parkinsonism, the name for a group of disorders with similar features and symptoms. Parkinson's Disease is also called primary parkinsonism or idiopathic Parkinson's Disease. The term idiopathic means a disorder for which no cause has yet been found. While most forms of parkinsonism are idiopathic, there are some cases where the cause is known or suspected or where the symptoms result from another disorder. For example, parkinsonism may result from changes in the brain's blood vessels.

What are the symptoms of Parkinson's disease?

The initial symptom of Parkinson's disease is a tremor that is worse while at rest and improves during movement. Other symptoms include:

  • Rhythmic back-and-forth motion of the thumb and forefinger

  • Slow movement

  • Muscle stiffness

  • Limbs that are rigid and resistant to movement

  • Loss of facial expressio

  • Shuffling gait

  • Drooling,

  • Dfficulty swallowing

  • A tendency to remain in one position

  • Depression

  • Dementia

  • Confusion

  • Hallucinations.

Diagnosis of Parkinson's Disease

No tests can conclusively show that you have Parkinson's disease. Your doctor will base a diagnosis on your symptoms, your medical history and the results of a clinical examination.

Your GP will ask you some questions and may get you to perform a task or walk around. This will help with the diagnosis.

In the early stages of Parkinson's disease, your GP may find it difficult to say whether you definitely have the condition because symptoms are usually mild.

If your GP suspects that you have Parkinson's disease, you will be referred to a specialist (a neurologist or geriatrician). If your GP thinks that you may be in the early stages of Parkinson’s disease, you should see a specialist within six weeks. If they think you may be in the later stages of Parkinson’s disease, you should see a specialist within two weeks.

Although no test can conclusively diagnose Parkinson’s disease, your specialist may offer you a test that will allow them to look more closely at your brain.

To help the specialist understand what is causing your tremor, you may be offered a scan of your brain called a SPECT scan (trade name DaT scan). This takes a series of pictures of your brain to find out whether there is any dopamine deficiency, which is seen in Parkinson's disease.

Your specialist may offer you an MRI scan. This can help them rule out other conditions that may have caused your symptoms.

Treatment of Parkinson's Disease

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. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. 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 be only 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, causing 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.

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 effect 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.

 

 

 
 

 

 
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