Parkinson’s Syndrome

Parkinson’s disease is a progressive neurological disorder which affects the control of body movements. It results from the progressive degeneration of neurons in a part of brain called substantia nigra. Dopamine-producing cells, known as dopaminergic neurons in the substantia nigra would be impaired. Gradually it causes falling of dopamine level in your body. Dopamine plays a key role in controlling your body movements.

Parkinson’s syndrome may be progressive or chronic. Chronic persists over a long period. In progressive, symptoms gradually get worse over time.

Parkinsons-syndrome
CAUSES

The exact cause of Parkinson’s syndrome is unknown. Most of the experts suspect that it may be caused by a combination of genetic and environmental factors.

  • Certain genetic mutations that contribute to this condition can be passed on genetically from family members
  • Environmental factors include prolonged exposure to toxins like insecticides, herbicides or fungicides
  • Use of MPTP, a synthetic neurotoxin, can also cause symptoms of Parkinson’s disease.

But no any genetic or environmental factors, alone, can be considered a cause of the disease.

RISK FACTORS

  • Male has 50% higher risk than females
  • Older age- Older people are at an increased risk.
  • Family history – Persons with their parents or siblings having Parkinson’s disease.

SYMPTOMS

Symptoms may be mild initially and may vary from person to person.

The most common symptoms of Parkinson’s syndrome are:

  • Tremors – Tremors are uncontrollable shaking usually begins in your hands or legs when you are resting. Tremors are more noticeable when you are at rest, stressed or tired. Continuous back-and-forth motion of your thumb and forefinger (pill-rolling) may be observed. Tremors may disappear when you start to move.
  • Bradykinesia (Slowness of movement) – Due to bradykinesia, a person may feel difficulty to initiate movements like starting to walk or getting out of a chair. It may cause slow blinking, lose of voice or facial expressions.
  • Muscle rigidity and stiffness- It usually occurs in the limbs and neck. Rigid muscle can cause poor arm swing and limiting of your normal movements.
  • Postural instability- Persons with Parkinson’s syndrome may show stooped posture and unsteady balance.

Apart from these, anxiety, depression, constipation, swallowing problems and sleeping disturbances may also be observed.

DIAGNOSIS

There is no specific test to diagnose Parkinson’s syndrome. Your doctor will diagnose Parkinson’s disease based on your symptoms, medical history and neurological examination.

Your doctor can confirm Parkinson’s syndrome if you have at least two of its major symptoms like tremors, bradykinesia, muscle rigidity or postural instability.

A sufficient dose of Levodopa would be given to you to observe your response to it. If you show significant improvement with this medicine, he will often confirm your Parkinson’s syndrome.

A neurological examination can evaluate patient’s problems related to tremors or bradykinesia.

A CT or MRI imaging tests can be performed to trace images of muscles, bones or any other part of the body.

TREATMENT

Parkinson’s syndrome can’t be cured. The main goal of treatment is to reduce severity of your symptoms and to thereby restore dopamine production in your body and to improve your overall heath. The effect of acetylcholine also needs to be blocked. Treatment includes medications, surgery, lifestyle changes.

MEDICATIONS

Medicines are used for treating Parkinson’s syndrome. But all medications may not be effective for all patients.

LEVODOPA

The most effective drug used to treat Parkinson’s syndrome. The combination of levodopa and carbidopa is sinemet. The conversion of levodopa into dopamine before reaching your brain can be prevented using sinemet. The symptoms like slowness to movement and rigidity can be effectively controlled with levodopa medication.

But the useful effect of levodopa may be short-lived and symptoms may return after years.

The most probable side effects are nausea, vomiting, difficulty swallowing, trouble breathing, abnormal and involuntary movements, restlessness, confusion and low blood pressure.

ANTICHOLINERGIC DRUGS are commonly prescribed drugs for treating tremors associated with Parkinson’s disease. These drugs can restrict the action of acetylcholine. Common anticholinegric drugs include biperiden, benztropine, procyclidine and trihexyphenidyl.

DOPAMINE AGONISTS such as bromocriptine and pramipexole can mimic the action of dopamine effects in your brain. These can directly stimulate dopamine receptors. It can produce side effects like hallucinations or sleepiness.

ANTIVIRAL DRUGS such as amantadine can enhance the dopamine balancing and improve your symptoms.
DEEP BRAIN STIMULATION

SURGERY

If medications cannot control your symptoms, surgery needs to be performed. Surgery is necessary for treatment of patients with severe motor fluctuations.

  • Deep brain stimulation
  • In this procedure, electrical stimulators (electrodes) would be implanted into the specific area of brain that controls your movement. It will be then connected to pulse generator implanted in your chest area. This will deliver impulses to the target area in your brain. More than 70 percent of patients are getting improvement from this surgical treatment. Risks of deep brain stimulation include bleeding, infection or seizures rarely.
  • In another type of surgery, the part of the brain which causes Parkinson’s syndrome would be destroyed.

LIFESTYLE CHANGES AND THERAPIES

  • Take a nutritionally balanced diet
  • Healthy exercises
  • Walking with care and avoiding falls
  • Avoiding stress
  • Make use of assistive devices such as wheelchairs, walkers, bed lifts etc.
  • Physiotherapy, speech and language therapy and occupational therapy