Charlotte, NC
Ritu Pokharel Dahal, MD
Gauri Adhikari, MD
Key highlights
1. Parkinson’s disease is caused by degeneration of dopamine-producing neurons.
2. Common muscular symptoms include resting tremors, bradykinesia (slowness of movement), muscle rigidity, and postural instability, impacting a person’s ability to move and perform daily activities.
3. Parkinson’s disease is typically diagnosed in mid to late adulthood, with an average age of onset around 60 years, although early-onset cases can occur before the age of 50.
4. While there is no cure for Parkinson’s disease, medications such as levodopa and dopamine agonists are prescribed to manage symptoms.
5. Deep brain stimulation surgery may be considered in advanced cases of Parkinson’s disease.
Parkinson’s Disease is a progressive neurodegenerative disorder that primarily affects movement. This motor system problem results from the loss of dopamine-producing brain cells. Dopamine is an important neurotransmitter that plays a vital role in the regulation of movement and coordination.
Parkinsonism is a comprehensive term encompassing a spectrum of neurological disorders that share common motor symptoms resembling those seen in Parkinson’s disease. Parkinson’s disease represents a specific and prevalent form of Parkinsonism. The progressive loss of dopamine-producing neurons in the brain marks Parkinson’s disease. In contrast, parkinsonism can arise secondary to various factors, such as certain medications, toxins, vascular changes, or other neurological disorders. These secondary forms, collectively known as atypical parkinsonian syndromes, include conditions like multiple system atrophy and progressive supranuclear palsy.
Parkinson’s disease primarily affects movement. Its symptoms often develop gradually over time, varying from person to person. The symptoms of Parkinson’s disease include:
People with Parkinson’s disease often show involuntary shaking or trembling, usually starting in one hand or fingers. The tremors are most noticeable when the affected limb is at rest.
Slowness of movement is a common feature of Parkinson’s disease. Patients may experience a gradual reduction in their ability to initiate and complete movements, leading to a general slowing down of everyday activities.
Stiffness or tightness of muscles can occur, making it difficult for individuals to move smoothly. This rigidity can be uncomfortable and may affect various parts of the body.
Postural Instability: People with Parkinson’s disease may have difficulty maintaining balance and an upright posture. This can increase the risk of falls.
Parkinson’s disease can cause changes in walking patterns, leading to a shuffling gait with shorter steps. This can contribute to difficulties in walking and maintaining balance.
A characteristic of Parkinson’s disease is the development of small, cramped handwriting. Over time, writing may become more difficult and less legible.
Individuals with Parkinson’s disease may experience changes in their voice, such as softness, monotone, or slurring. Communication difficulties may arise as a result.
Reduced facial expressions, often called a “masked face,” can occur, giving the impression of decreased emotional expressiveness.
The incidence increases significantly with advanced age, with an average age of onset of about 70 years. A small number of patients experience “early-onset” disease, meaning their symptoms start before the age of 50.
This is the most common type of Parkinson’s disease, where the cause is unknown. Scientists believe that idiopathic Parkinson’s disease is due to the misfolding of alpha-synuclein protein that gets deposited in various parts of the brain as clumps called Lewy bodies.
Individuals who have one or more close relatives with Parkinson’s disease are at a higher risk of getting the illness themselves. An estimated 10 percent of patients have a familial cause of Parkinson’s disease. Certain genetic mutations have been linked to this disease.
Certain drugs like phenothiazine, risperidone, and metoclopramide are found to cause symptoms similar to parkinsonism and are called drug-induced parkinsonism. This type can get better after reducing the dose or stopping the drug. However, in some cases, the effects can stay for longer, even after stopping the drug.
Occasionally, exposure to toxins like manganese dust, fumes, or certain pesticides has been recognized as the cause of Parkinsonian disease. However, they are yet to be confirmed.
People who have repeated head injuries in sports like boxing, hockey, football, etc, are also found to have post-traumatic parkinsonism.
Diagnosing Parkinson’s disease involves a comprehensive evaluation by a healthcare professional, usually a neurologist. There are no definitive tests for Parkinson’s disease, so the diagnosis is based on clinical assessments, medical history, and the presence of characteristic symptoms. The tests that are performed are as follows:
Blood tests are usually performed to rule out other conditions like toxins or drug exposure.
CT scan is an imaging test that uses a series of X-rays and a computer to create a detailed brain image. In contrast, MRI uses the magnetic field to create similar images. These tests help to rule out other structural brain abnormalities that may mimic Parkinson’s disease.
In cases with a family history of Parkinson’s disease or early-onset cases, genetic testing may be considered to identify specific genetic mutations associated with familial forms of the disease.
This is a new approach to diagnosing the condition. Researchers have suggested two tests to detect the protein involved in Parkinson’s disease that can be a possible marker. The tests are a spinal tap and study of cerebrospinal fluid (CSF) to look for misfolded protein, and the other one is a biopsy of nerves on the skin surface.
While there is no cure for Parkinsonism, various treatment strategies focus on improving quality of life, managing symptoms, and providing support. Here are key aspects of the management of Parkinsonism.
In Parkinson’s disease, there is not enough dopamine. Providing your body with dopamine is central to the treatment of the condition. Levodopa is a precursor to dopamine, and it helps replenish dopamine levels in the brain and alleviate motor symptoms. It is usually used in combination with a drug named carbidopa, which helps to stop the premature conversion of levodopa to dopamine outside of the brain. The drug, however, causes side effects like dizziness, orthostatic hypotension, anxiety, dyskinesia, confusion, and even hallucination in some cases. Over time, the effectiveness of levodopa can change due to the changes your body goes through so it might need dose adjustments later in the process.
Drugs like pramipexol and ropinirole are dopamine agonists. These medications mimic the effects of dopamine and can be used alone or in combination with levodopa. The side effects of this drug are similar to those of levodopa but are milder than those of levodopa itself.
These are drugs like entacapone, tolcapone and amantadine. These medications help increase the duration of the effects of levodopa by stopping its breakdown in the body. The side effects of these drugs include dyskinesia, diarrhea, nausea, ankle swelling, skin color changes, and even hallucination.
Patients with parkinsonism also need treatment for conditions like erectile dysfunction, constipation, sleep-related issues, or depression.
DBS is one of the most commonly discussed surgical procedures used as a treatment for Parkinson’s disease and other movement disorders. For the procedure, a particular type of electrode is implanted into specific brain regions, which are then connected to a neurostimulator, a device similar to a pacemaker placed under the skin near the collarbone. This neurostimulator sends electrical impulses to the brain, modulating abnormal neural activity and alleviating motor symptoms associated with Parkinson’s disease. DBS is typically considered for individuals with advanced Parkinson’s disease who have motor complications, such as fluctuations in medication effectiveness (wearing-off) and medication-induced dyskinesias (involuntary movements). Candidates for DBS undergo a thorough evaluation, including neurological assessments, imaging studies, and psychological evaluations, to ensure they are suitable candidates.
Occupational therapy aims to help individuals with Parkinson’s disease perform daily activities more independently. Your therapy team may suggest adaptive strategies and techniques to address difficulties in tasks such as dressing, writing, and cooking. Speech therapy can help manage speech and swallowing problems that may arise in Parkinsonism. Exercises and techniques are employed to improve communication and reduce the risk of aspiration.
Referral to a neurologist is crucial in the comprehensive management of Parkinson’s disease. Typically initiated by primary care physicians, these referrals are critical for a specialized evaluation that includes a thorough neurological examination, detailed medical history assessment, and diagnostic testing to differentiate Parkinson’s disease from other movement disorders. In cases of advanced Parkinson’s disease, neurologists may consider referrals for DBS surgery to alleviate motor complications. Care from a neurologist ensures that individuals with Parkinson’s disease receive specialized care tailored to their unique needs, fostering optimal management and support.
