Parkinson’s Disease

What is Parkinson’s disease?

Parkinson’s disease is a neurological syndrome usually resulting from deficiency of a brain chemical known as dopamine. The disease is characterized by rhythmic muscular tremors which are progressive. It is also known as shaky palsy but the condition is much more complex than simply the tremors characteristic of the disease. There is no complete cure for the disease and it is treated symptomatically. Life expectancy of the patient reduces considerably if no treatment is provided.

What are the symptoms of Parkinson’s disease?

All different causes of Parkinson disease lead to similar symptoms. Some of the main symptoms are disorders of movement such as tremor, postural instability or gait difficulty. The tremors usually affect the terminal part of the extremities and are more common in the hand. The tremors are usually present at rest and absent during sleep.

The routine movements of the person are slow (bradykinesia) or there is a complete lack of movement. The same is seen with expressions. Emotional reactions are also slower as the condition progresses. Rigidity is present and there is change in handwriting and voice of the patient. The volume of voice is reduced and the patient might speak hurriedly and later on as the disease progressive could just whisper.

Short term or intermediate memory loss may be seen. In severe cases, and those that do not respond well to treatment, there is a significant degree of disability and morbidity. Parkinson disease like symptoms along with lack of urinary control, impotence and orthostatic hypotension is seen in Shy-Drager syndrome and the two should not be confused.

What causes Parkinson’s disease?

The exact cause of Parkinson’s disease is unknown although the disease process is better understood these days. Even the risk factors are unknown in majority of cases.  There are some genetic factors seen to be involved in Parkinson disease. Although dopamine deficiency due to death of dopamine-producing nerve cells is the main reason for the symptoms, the exact reason why these specific cells are destroyed has not been conclusively identified.

Traumatic parkinsonism follows major cranial trauma caused due to brain tissue damage in the area of trauma. Toxic substances such as carbon monoxide, manganese, carbon disulphide, MPTP and drugs (for example phenothiazine and butyrophenones) can cause parkinsonism. However, in most cases of Parkinson’s disease these events, substances and risk factors are not present.

How is Parkinson’s disease treated?

Despite a number of possible causes of the disease, the therapeutic strategies utilized remain similar. The goal of treatment of Parkinson disease is to enhance dopamine function in the body. Levodopa is a very effective drug in the treatment of Parkinson disease. The dose of levodopa is carefully controlled for maximum benefit with minimal side effects. Levodopa can be used in combination of carbidopa. Other drugs that can be used are amantadine, bromocriptine, trihexyphenidyl, procyclidine, cycrimine, biperiden, diphenhydramine, chlorphenoxamine and selegiline. Despite the effectiveness of levodopa and other drugs, over time the responsiveness to medication decreases. Dosages have to be increased and ultimately is not able to completely resolve symptoms for even short periods.

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