Parkinson's Disease

Parkinson's Disease

Parkinson’s disease is a progressive degenerative disorder of the nervous system. It occurs due to death of nerve cells in the portion of the mid brain that controls body movements. Symptoms of Parkinson’s disease develop gradually with a barely noticeable tremor that progress to stiffness and slowing of movements. As the disease advances, cognitive symptoms, depression and other emotional disturbances are common.

Parkinson’s disease usually affects individuals between the ages of 50 and 65 and is common in men than women. Medications are beneficial in the early stage of the disease and surgery may be indicated later on.

Body movements are controlled by a portion of the brain called the basal ganglia. Cells of the basal ganglia require a balance between two substances; dopamine and acetylcholine. When the dopamine producing nerve cells are destroyed, it causes abnormal brain activity, leading to signs of Parkinson’s disease.

The exact Parkinson’s disease cause is not known in majority of the cases. Parkinson’s disease risk factors include:

  • Genetics
    Around 20% of cases are caused due to certain genetic mutations and variations.
  • Environmental factors
    Exposure to toxins in the environment like insecticides, pesticides and heavy metals has been associated with an increased risk.

Other causes include adverse reaction to prescription drugs, thyroid disorders, repeated head trauma and any condition affecting the brain.

Parkinson’s disease symptoms appear gradually and may go unnoticed at the start. They usually begin on one side and remain worse on that side even as the condition worsens.

Symptoms can be divided into motor (movement related) and non-motor symptoms (neuropsychiatric).

Motor symptoms

The four major motor symptoms are:

  • Tremor
    This is the most common and seen when the limb is at rest.
  • Rigidity
    This is seen by the stiffness in the limbs and the resistance to movement due to excessive and continuous contraction of muscles. As the disease progresses, rigidity affects the entire body and reduces the ability to move.
  • Slowness of movement
    This is a very disabling symptom since the start of the disease. It hinders performing daily tasks like writing, typing or sewing.
  • Postural instability
    This is seen in the later stages of the disease. It leads to an imbalanced posture and gait causing frequent falls and associated fractures.

Other motor signs and symptoms include speech changes, stooped posture, loss of involuntary movements, mask like facial expression and small handwriting.

Non-motor (neuropsychiatric) symptoms

  • Cognitive disturbances
    These include problems with planning, thinking, fluctuations in attention and poor memory recall. The risk of dementia is higher in people suffering from Parkinson’s.
  • Mood and behavior changes
    The most common mood changes seen are depression, anxiety and apathy.
  • Psychotic symptoms
    such as hallucinations and delusions are seen in around 4% of cases.
  • Sleep disorders
    leading to excessive day time sleepiness or insomnia.

An impaired sense of smell, sensation of pain and tingling and numbness in the skin are some of the other symptoms.

Parkinson’s disease diagnosis is made on the basis of medical history, review of signs and symptoms, physical and neurological examination.

Imaging tests such as Magnetic resonance imaging (MRI) and Computed tomography (CT), Dopamine transporter (DAT) are done to rule out other conditions and confirm a diagnosis of Parkinson’s disease.

Levodopa, which is a Parkinson’s disease medication maybe administered to see its effect. Significant improvement with this medication confirms the diagnosis of Parkinson’s disease.

Diagnosis may take a long time since it requires the physician to observe the patient’s signs and symptoms over a period of time. Therefore, it is essential to go for regular follow ups and consultations with the doctor.

Parkinson’s disease treatment includes medications and surgery that can provide symptomatic relief and improve the quality of life. Lifestyle changes, physical therapy and speech language therapy also help in treating Parkinson’s disease.

Medical treatment of Parkinson’s disease

Parkinson’s disease causes a reduction in brain dopamine concentrations. Since dopamine cannot be administered directly, certain drugs that increase the level of dopamine are used for PD treatment. Commonly prescribed drugs include levodopa, dopamine agonists, MAO-B inhibitors, Catechol O-methyltransferase (COMT) inhibitors, anticholinergics, amantadine and adenosine receptor antagonists (A2A receptor antagonist).

Long term use of Levodopa is known to cause involuntary movements called dyskinesias. To avoid this, therapy with levodopa is delayed as far as possible.

Surgical treatment of Parkinson’s disease

Surgical treatment involves deep brain stimulation (DBS). The surgeon implants electrodes into a specific part of the brain and connects them to a generator implanted in the chest. The generator sends electrical impulses to the brain, which can reduce disease symptoms. DBS is usually performed in patients with advanced Parkinson’s disease who show poor response to medications.

MRI-guided focused ultrasound (MRgFUS) is an advanced surgical treatment that has helped in managing tremors common in Parkinson’s disease. The ultrasound is guided by an MRI to the area in the brain where the tremors start.

The Centre for Neurosciences at Kokilaben Dhirubhai Ambani Hospital, Indore has the best doctors for Parkinson’s disease. The Centre is equipped with modern machines and technologies to provide the best Parkinson's disease treatment in Indore.