What is Parkinson’s Disease? Symptoms, Complications and Treatment.

INTRODUCTION:

Parkinson's disease (PD) is a slowly progressive neurological disorder that affects movement, muscle control, and balance.  Parkinson’s disease is part of a group of conditions called motor system disorders, which are associated with the loss of dopamine-producing brain cells.  These dopamine-associated motor disorders are referred to as parkinsonisms.  The disease develops gradually (disease process develops as cells are destroyed in certain parts of the brain stem, particularly the crescent-shaped cell mass known as the substantia nigra), sometimes starting with a barely noticeable tremor in just one hand.  But while a tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement.  In Parkinson's disease, your face may show little or no expression, or your arms may not swing when you walk.  The speech then becomes slurred or soft.  Parkinson's disease symptoms worsen, as the condition progresses over time. 

SIGNS AND SYMPTOMS:

  1. Tremor.  A tremor, or shaking, usually begins in a limb, often your hand or fingers.  You may notice a       back-and-forth rubbing of your thumb and forefinger, known as a pill-rolling tremor.  One characteristic of Parkinson's disease is a tremor of your hand when it is relaxed (resting tremor).
  2. Rigid muscles.  Muscle stiffness may occur in any part of your body.  The stiff muscles can limit your range of motion and cause you pain.
  3. Slowed movement (bradykinesia).  Over time, Parkinson's disease may reduce your ability to move and slow down your voluntary movement, making simple tasks difficult and time-consuming.  Initiating a movement is slow.  Your steps may become shorter when you walk (shuffling gait), or you may find it difficult to get out of a chair.  Also, you may drag your feet as you try to walk, making it difficult to move.
  4. Impaired posture and balance. Your posture is a stooped posture, or your balance may have a problem, as a result of Parkinson's disease.
  5. Face expression.  The disease is characterized by an expressionless face (mask-like facies).  There is decreased eye blinking.
  6. Loss of automatic movements. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling, or swinging your arms when you walk.
  7. Speech changes.   You may speak softly, quickly, slur, or hesitate before talking.  Your speech may be more monotonous rather than with the usual inflections.
  8. Writing changes.  It may become hard to write, and your writing may appear small (micrographia).
  9. Lightheadedness or fainting.  When standing (orthostatic hypotension).

CAUSES:

  1. Age – a disease of the middle age and elderly (around 60 years).
  2. Sex – Men are more affected than women.
  3. Genetic factors - Specific genetic mutations appear to play a strong role in early-onset Parkinson's disease.
  4. Environmental factors - Environmental factors may trigger the condition in people who are genetically susceptible.
  5. Pesticides and herbicides are implicated.
  6. People living in rural areas employed as agriculturists and those who drink well water.

PARKINSON’S STAGES:

Stage one:  The patient experiences mild symptoms, such as tremors or shaking in a limb.  Friends and family can usually detect changes such as poor posture, loss of balance, and abnormal facial expressions.

Stage two:  The patient's symptoms are bilateral, affecting both limbs and both sides of the body.  The person usually encounters problems walking or maintaining balance, and the inability to complete normal physical tasks.

Stage three:  The symptoms can be rather severe and include the inability to walk straight or to stand.  There is a noticeable slowing of physical movements.

Stage four:  The patient's walking may still occur, but it is often limited, and rigidity and bradykinesia -- a slowing of movement -- are often visible.  Most patients are unable to complete day-to-day tasks, and usually cannot live on their own.

Stage five:  The patient is usually unable to take care of himself or herself and may not be able to stand or walk.  A person at stage five usually requires constant one-on-one nursing care.

COMPLICATIONS:

  1. Thinking difficulties.
  2. Depression and emotional changes such as fear, anxiety, loss of motivation, etc.
  3. Swallowing problems - leading to drooling of saliva.
  4. Sleep problems and sleep disorders - daytime somnolence with disturbed night sleep.
  5. Bladder problems - unable to control urine.
  6. Constipation.
  7. Smell dysfunction.
  8. Fatigue.
  9. Pain.
  10. Sexual dysfunction - decrease in sexual desire or performance.

DIAGNOSES:

There's no precise test for Parkinson's disease. Diagnosis is usually made by the history, physical examination, and neurological examination.

Imaging tests:

SPECT or PET Scan:  To assess the activity and brain function involved in movement.

CT Scan: CT uses x-rays and computers to produce images of the brain.

MRI Scan: MRI produces very clear pictures and uses radio waves and a computer.

Parkinson’s Markers:

  1. The presence of Lewy bodies, which are clumps of specific substances within brain cells --- microscopic markers of Parkinson's disease.
  2. The presence of widespread protein called alpha-synuclein (A-synuclein) in all the Lewy bodies in a clumped form --- is a research finding.

TREATMENT:

Parkinson's disease can't be cured, but medications can help control your symptoms, often dramatically.  In some later cases, surgery may be advised.  Medications may help you manage problems with walking, movement, and tremor.  These medications increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in your brain.

MEDICATIONS:

The medications commonly used are:

  1. Levodopa (also called L-dopa)
  2. Levodopa with carbidopa (Sinemet, Rytary).

Other medications tried are:

  1. Dopamine agonists (pramipexole (Mirapex), ropinirole (Requip) and rotigotine (given as a patch, Neupro), and a short-acting injectable dopamine agonist, apomorphine (Apokyn).
  2. Symmetrel.
  3. Anticholinergics (Artane and Cogentin (benztropine)
  4. MAO-B inhibitors:  These medications include selegiline (Eldepryl, Zelapar) and rasagiline (Azilect).
  5. COMT Inhibitors (entacapone (Comtan) and tolcapone (Tasmar). 
  6. Amantadine.

SURGICAL:

DBS – Deep brain stimulation:

The system is implanted by a team consisting of functional stereotactic neurosurgeon (neurosurgeon who has specialized in treating central nervous system functional disorders) along with clinical and electrophysiological guidance of a movement disorder specialist (trained in the Parkinson’s disease, tremor, dystonia, etc.) trained in these procedures. The neurosurgeon uses stereotactic head frame and imaging (MRI) to map the brain and locate the target within the brain.   The lead is inserted through a small opening in the skull and implanted in the targeted site deep within the brain.

The deep brain stimulation works by modifying the electrical activity of the subthalamic nucleus (STN) deep in the brain, which is involved in motor control.  Electrical signals are produced by a neurostimulator (the external source) that is implanted beneath the skin near the collarbone of the patient.  The signals are delivered to the brain via a thin, insulated coiled wire that is implanted in the STN. The electrical stimulation can be adjusted from outside.  In addition, the patient can turn the stimulation completely off, when it is not required, although most patients will require and prefer to leave the neurostimulator “on” all the time. 

Tags: Parkinson’s , neurology , disorder , Disease , Stiffness , Deep Brain Stimulation

 

Was this article helpful?

© 2016 Columbia Asia

Google+