The Facts on Parkinson's Disease -
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Parkinson's Disease
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What is Parkinson's Disease?

Parkinson's disease is a degenerative disease of a part of the brain called the substantia nigra. In patients with Parkinson's disease, this part of the brain (that normally helps control motion) slowly stops working. Parkinson's disease generally affects people who are elderly, but on occasion Parkinson's disease occurs in people in their 40s. Importantly, Parkinson's disease is not inherited.

What are the symptoms of Parkinson's disease?

Parkinson's disease has several classic symptoms including tremor, stiffness of the limbs, mask-like face, gait disturbance (difficulty walking), and dementia.

Resting tremor: especially of the hands and fingers. This is described as a "pill rolling" tremor. The name is derived from the similarity of the tremor's movement to that required to "roll a pill" in early pharmacies. In the early stages of the disease, the tremor stops when the person does something active, such as opening a door.

Stiffness of the limbs and difficulty initiating (starting) movements: In the early stages of the disease, this may show up as trouble running, etc. As the disease worsens, the patient may have a difficult time initiating activities such as walking or dressing.

Mask-like face: Along with a limited capacity in moving the extremities, a patient with Parkinson's disease also experiences a decreased ability in moving the muscles of the face. The facial expression tends to be unchanging as a result, and, therefore, "mask like."

Gait disturbance: Another manifestation of Parkinson's disease is difficulty stopping an action once it has been initiated. For instance, patients may have trouble stopping once they do start walking. This is medically referred to as a "festinating" gait. Affected individuals may go faster and faster until they fall or hit some object in their path.

Dementia (memory loss) and depression: One in five individuals with Parkinson's disease develops memory loss and up to 50% of patients are affected by depression. Additionally, some people with Parkinson's disease may have hallucinations (seeing and hearing things that are not real).

Other symptoms which can occur with Parkinson's disease are decreased blinking, stooped posture, and increased saliva production.

How fast does Parkinson's disease worsen?

The course of Parkinson's disease varies from patient to patient. It varies from slowly progressive over many years to rapidly progressive within many months.

What other conditions can be similar to Parkinson's disease?

A number of medications including those used for nausea (especially metoclopramide (Reglan) and for psychiatric problems, such as schizophrenia (for example Haldol and Mellaril), can cause Parkinson's-like symptoms. Carbon monoxide, cyanide, and manganese poisoning, as well as other neurologic illnesses (brain diseases) can also result in a Parkinson's-like condition.

Finally, some families have an inherited tremor that can be mistaken for Parkinson's disease. However, this "benign essential tremor" may respond to alcohol (in small amounts!) and is not present at rest. This is the opposite of Parkinson's disease where the tremor is present at rest.

Is there any treatment for Parkinson's disease?

Yes. There are a number of medications that can be used to help control the symptoms of Parkinson's disease such as the tremor and stiffness. However, no medications have yet been developed that stop the progression of Parkinson's disease.

Medications used to help control the symptoms of Parkinson's disease include selegiline, artane, cogentin, amantadine, and carbidopa/levodopa. Selegiline (Eldepryl) is thought to protect the area of the brain that stops working in Parkinson's disease and thus slow the course of the illness. However, there is no benefit after 4 years of therapy and there are multiple side effects. In fact, even though it may help Parkinson's disease, selegiline may actually increase the death rate in those patient's treated with it. Artane and cogentin are examples of anticholinergic medications which are similar to diphenhydramine (Benadryl). These drugs can be used to treat the tremor. However, they may cause constipation, blurred vision, and confusion, however. Amantadine can be used to control tremor and trouble initiating activities. Carbidopa/Levodopa (Sinemet), a combination of two drugs, is currently the mainstay of therapy for Parkinson's disease. This combination can help control tremor and slowing and is effective long term. Side effects including hallucinations and confusion.

Non-medical treatments, such as structuring the environment to minimize confusion and injuries, family support groups, etc. are also very important in helping patients with Parkinson's disease function.

Surgical treatments for Parkinson's disease include operations to repair the affected areas of the brain or transplant tissues to the brain that send hormones to these areas. These procedures have been tried with some success. However, none has been shown to be routinely effective.

Parkinson's Disease at a glance

  • Parkinson's disease is degenerative (progressive) disease of the part of the brain that controls movement.
  • Parkinson's disease is found mostly in elderly people, but may occur in people as young as 40 years of age.
  • The signs of Parkinson's disease include tremor (shakiness), stiffness, stooped posture, and trouble starting movements.
  • While there are no medications that can stop Parkinson's disease from progressing, many good medical therapies are available for its symptoms.

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