Parkinson’s disease also called paralysis agitans or shaking palsy is a movement disorder. Cases of PD are reported at all ages, though it is uncommon in people younger than 40.

This disease is more common among men and usually occurs after 60 years.

The average age at which symptoms begin in the USA. is 58-60.

The nerve cells in the part of the brain which controls movements are mainly affected. The nerve cells (neurons) which make the chemical called dopamine either don’t work sufficiently or are completely destroyed. The real cause behind this had never been identified. Though, many risk factors have been enumerated in the literature.

Symptoms:

Persons suffering from Parkinson’s disease need not present with every common symptom. The number of symptoms and their intensities is known to vary with every individual. Most common signs & symptoms of Parkinson’s include:

• Tremors were felt in the fingers, hands, arms, legs, jaw, and face. Initially, these tremors are mild and visible only while resting. Eventually, they become visible even during routine movements.
• Rigidity is another symptom. Persons suffering often feel stiffness or inflexibility in their muscles. Muscles normally stretch when they move, and then relax when they are at rest. In rigidity, the muscle tone of an affected limb is always stiff and does not relax, sometimes resulting in a decreased range of motion.
  Muscular movements like walking, running, dancing, sitting, and grasping objects with fingers all seem very stiff. The rigidity can cause pain and cramping. The sense of fluidity in these movements is lost. In advanced conditions, even the facial muscles become very rigid, thus giving an appearance of an expressionless face, something akin to wearing a mask.
• Bradykinesia or slowness of movements usually accompanies the sensation of stiffness and rigidity. A person with bradykinesia will probably also have incomplete movements, difficulty initiating movements, and sudden stopping of ongoing movement.

  There is an increasing inability to perform tasks that require rapid alternating movements.

• Loss of balance and the coordination of movements results in frequent falls when beginning to walk or run.
• Gait: There is a ‘shuffling’ gait characterized by short steps, with feet barely leaving the ground, producing an audible shuffling noise. Small obstacles tend to trip the patient.
• Decreased arm swing. Turning ‘en-bloc’, rather than the usual twisting of the neck and trunk and pivoting on the toes, PD patients keep their neck and upper body rigid, requiring multiple small steps to accomplish a turn. Stooped, forward-flexed posture both when sitting and standing. Festination: a combination of stooped posture, imbalance, and short steps. It leads to a gait that gets progressively faster and faster, often ending in a fall.
• Dystonia: abnormal, sustained, painful twisting muscle contractions, usually affecting the foot and ankle, interfering with gait. However, dystonia can be quite generalized, involving a majority of skeletal muscles; such episodes are very painful and completely disabling.

  They may go through periods of "freezing", which is when a person feels stuck to the ground and finds it difficult to start walking. The slowness and incompleteness of movement can also affect speaking and swallowing.

  • Speech: the voice becomes very soft. Later, the sound turns hoarse and monotonous. Occasionally, the speech becomes excessively rapid, soft, and poorly intelligible.

    Gradual progress in the disorder causes an inability to understand the meaning & essence of speech. Also, there is difficulty in deciphering the facial expressions seen on others when conversing.

  • Drooling: Weak swallowing and stooped posture causes drooling of saliva. More symptoms that are seen in PD are:
  • Small, cramped handwriting (micrographia)
  • Dementia and confusion
  • Fear or anxiety
  • Slow thinking & memory problems
  • Sexual dysfunction
  • Fatigue and body aches
  • Compulsive behaviors
  • Loss of energy
  • Sleep disturbances: excessive daytime sleepiness; insomnia; vivid, disturbing dreams.

These symptoms certainly vary in intensities in different persons. They are seen as the disease progresses and everyone does not suffer from all of them.

Pathogenesis:

We now know that many of the signs and symptoms of Parkinson's disease develop when certain nerve cells (neurons) in an area of the brain called the substantia nigra are damaged or destroyed. Normally, these nerve cells release dopamine — a chemical that transmits signals between the substantia nigra and another part of the brain, the corpus striatum. These signals cause your muscles to make smooth, controlled movements.

As a normal part of aging, everyone loses some dopamine-producing neurons.

People with Parkinson's disease lose half or more of the neurons in the substantia nigra. Although other brain cells also degenerate, the dopamine-containing cells are critical for movement and so their damage takes center stage.

Causes of Parkinson's disease:

Why Parkinson's Disease occurs, no one knows. These are some factors that scientists believe predispose individuals to PD.

• Genetic factors: About 15 to 25 percent of people with Parkinson's report having a relative with the disease. This means that if your parent has Parkinson's, your chances of developing the disease are slightly higher than the risk in the general population.
• Studies have revealed that there may be more of a genetic basis to young-onset PD (that is, the 10 percent or so of people with Parkinson's for whom onset occurs at or before age 50) than to later-onset PD.
• The vast majority of Parkinson's cases are not directly inherited, but researchers have discovered several genes that can cause the disease in a small number of families. Genetic diseases occur when important genes contain mutations, which result in abnormal proteins that in turn cause disease.
• Environmental factors: Scientists have suggested that Parkinson's disease may result from exposure to an environmental toxin or injury. Research has identified several factors that may be linked to PD, including rural living, well water, herbicide use, and exposure to pesticides. Pesticides are thought to adversely affect the brain by inhibiting energy production resulting in brain cell death.

  Studies have also shown that smoking and caffeine use appear to protect against the development of PD. However, it is universally agreed that the health risks associated with smoking are worse than any incidental benefits that might be gained by this habit.

  Also, a synthetic narcotic agent called MPTP can cause immediate and permanent Parkinsonism if injected.

• Head trauma:

  Past episodes of head trauma are reported more frequently by sufferers than by others in the population.
• Drug-induced: Antipsychotics, which are used to treat schizophrenia and psychosis, can induce the symptoms of Parkinson's disease (or parkinsonism) by lowering dopaminergic activity.

Diagnosis:

Currently, no blood or laboratory tests have been proven to help in diagnosing PD. It is difficult to diagnose PD accurately. Thus, medical history and a neurological examination alone guide the physician in diagnosing.

The Unified Parkinson's Disease Rating Scale (UPDRS) is a rating scale used to follow the longitudinal course of Parkinson's disease.

Related conditions: There are a number of disorders that mimic Parkinson’s disease in some of their symptoms. On close examination though, they are distinguisale from idiopathic PD. These conditions, fortunately, have additional symptoms which do not occur in PD.Such disorders need to be ruled out before establishing a diagnosis of PD.

• Multiple System Atrophy(MSA)
  • Cerebellar ataxia
  • pyramidal weakness
  • autonomic failure (previously known as Shy-Drager syndrome)
  • nocturnal stridor
• Progressive Supranuclear Palsy(PSP)
  • failure of voluntary vertical eye movements
  • early dementia
• Corticobasal degeneration(CBD)
  • cognitive impairment
  • apraxia
  • myoclonus
• Dementia with Lewy bodies(DLB)
  • early cognitive impairment
  • hallucinations
• Olivopontocerebellar Atrophy(OPCA)
  • ataxia
  • dysarthria
• Wilson’s Disease
• Torsion dystonia

These Parkinson-plus syndromes are usually more rapidly progressive and less likely to respond to anti-parkinsonian medication than Parkinson's disease. However, the additional features of the disease may respond to medications not used in Parkinson's disease.

Treatment options for Parkinson's Disease

Conventional treatment

There is no permanent cure for PD. Though many patients show dramatic responses to medications initially, with gradual progress, the benefits of drugs diminish.

Treatment usually comprises of: -

• Medications
• Counseling
• Physical therapy
• Surgery

Medications: medications help control the problems faced in walking, movements, and tremor. However, they need to be taken in various combinations which need to be changed every little while. The medicines used are:

• Levodopa and Carbidopa: Levodopa had been the ‘gold standard for treating PD since its introduction in 1960. levodopa is a naturally occurring substance in nature. It is a precursor of the chemical dopamine which gets converted to dopamine by the nerve cells in the brain. There is a fine meshwork-like structure in the brain that acts like a filter that allows only selective substances to cross through and enter the brain. This structure is called the blood-brain barrier. Dopamine itself cannot cross this barrier, but levodopa can. Hence, dopamine itself is never prescribed in PD. Unfortunately, though the side effects of these drugs(nausea; postural reduction in blood pressure) are not major, their doses need to be frequently regulated. The quantity of each dose as well as its frequency of repetition keeps increasing lifelong.

  These medicines nevertheless allow persons suffering to extend the period for which they can lead a normal life.

• Dopamine agonists: though not levodopa, these drugs mimic the action of levodopa and cause neurons to behave as though they are receiving dopamine.

  This class of drugs includes:

  • Bromocriptine (Parlodel),
  • Apomorphine (Apokyn),
  • Pramipexole (Mirapex) and
  • Ropinirole
• Selegiline: This drug helps prevent the breakdown of dopamine.
• Catechol-O-methyltransferase: These drugs prolong the actions of levodopa and carbidopa by preventing an enzyme from breaking down dopamine.
• Anticholinergics: These are used to control the tremors. But, often the side effects (loss of memory, hallucinations, confusion, dry mouth, nausea, urine retention, severe constipation) make their use undesirable.
• Amantadine: Provides short-term relief from early, mild Parkinson’s disease. Side effects (swollen ankles, purple mottling of skin) are not very severe.
• Co-enzyme Q10: The majority of the energy utilized by the cell is produced within the mitochondria. This is a substance present within the mitochondria of the cells. Co-enzyme Q10 is responsible for electron transport by which the cell derives energy from Oxygen during respiration. Surgery
  • Thalotomy: destroys a few tissues within the thalamus (a major center in the brain handling the relay of messages and transmitting sensations. This procedure reduces tremors in some people. Though, it can cause slurring of speech and lack of coordination in movements.
  • Pallidotomy: this procedure consists of removing tissues within the pallidum (a part of the brain responsible for causing PD). Tremors, rigidity, and slowness of movements are all controlled by this procedure. Though the procedure provides relief, the effects are not long-lasting and the condition usually recurs. Slurred speech, vision problems, and severe weaknesses are some of the side effects.
  • Deep brain stimulation: A small device that transmits electrical impulses is planted deep within the brain from where it stimulates the sub-thalamic nucleus which controls many motor functions. This procedure however runs the risk of developing a bleed (hemorrhage) like a stroke. There are high incidences of developing an infection as well. Hence, this procedure is the last option.

Counseling

Certain changes in diet and lifestyle can go a long way in improving a person coping skills with PD.

Healthy eating

Eat more fruits, vegetables, and whole grains.

These foods are high in fiber, which is important for helping prevent constipation. Also, drink plenty of water and increase fibre intake through supplements.

Healthy Exercise

Regular exercise is extremely important if you have Parkinson's disease. It helps improve mobility, balance, range of motion, and even emotional well-being. Your doctor or physical therapist may recommend a formal exercise program, but any physical activity, including walking, swimming, or gardening, is beneficial. Weight-bearing exercises, such as walking, jogging, and dancing, may be helpful.

Keep in mind that your energy level may go up and down, and you'll sometimes need to pace yourself. If you're tired, try doing one part of your routine at one time of day and adding another segment later. Choose a time to exercise when your medicines are working well and you feel strong.

Be sure to stretch before and after you exercise. Stretching warms up your muscles, helps prevent stiffness, and improves your flexibility and balance.

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Walking with care

Parkinson's disease can disturb your sense of balance, making it difficult to walk with a normal gait. These suggestions may help:

• If you notice yourself shuffling, slow down and check your posture. It's best to stand up straight with your head over your hips and your feet eight to 10 inches apart.
• Buy a good pair of walking shoes. Avoid running shoes.
• Practice taking long steps and exaggerating lifting your legs and swinging your arms.
• If you become stuck in place — known as freezing ¾ rock gently from side to side or pretend you're stepping over an object on the floor.

Avoiding falls

In the later stages of the disease, you may fall more easily. That's because Parkinson's disease affects the balance and coordination centers in the brain. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help:

• Ask your doctor or physical therapist about exercises that improve balance, especially Tai chi. originally developed in China more than 1,000 years ago, tai chi uses slow, graceful movements to relax and strengthen muscles and joints.
• Wear rubber-soled shoes. They're less likely to slip than shoes with leather soles.
• Remove all area rugs from your home and make sure carpeting is secured firmly to the floor.
• Install handrails, especially along stairways.
• Keep electrical and telephone cords out of the way.
• Install grab bars around your tub and beside the toilet.
• Make sure you can reach the telephone from your bed and carry a cordless phone with you during the day.

Dressing

Dressing can be the most frustrating of all activities for someone with Parkinson's disease. The loss of fine motor control makes it hard to button and zip clothes, and even to step into a pair of pants. A physical therapist can point out techniques that make daily activities easier. These suggestions also may help:

• Allow plenty of time so you don't feel rushed.
• Lay clothes nearby.
• Choose clothes that you can slip on easily, such as sweat pants, simple dresses, or pants with elastic waistbands.
• Look for clothes and shoes with fabric fasteners, such as Velcro, or replace buttons on clothes you have with fabric fasteners.

Speaking

Even in the early stages of Parkinson's disease, your voice may become very soft or hoarse. To communicate more easily:

• Face the person you're talking to, and deliberately speak louder than you think is necessary.
• Practice reading or reciting out loud, focusing on your breathing, and on having a strong voice.
• Speak for yourself — don't let others speak for you.
• Consult a speech-language pathologist who is trained to treat people with Parkinson's disease.

Movement Therapies

It May help people with Parkinson's improve motor skills and balance and help them walk better.

• Music therapy: A recent study showed symptoms improved with music and dance therapy compared to physical therapy
• Alexander Technique emphasizes posture and balance. It May help improve mobility and gait
• Feldenkrais Method: aims to re-educate the body about movements that are difficult. May improve gait

Nutritional supplements:

Many supplements may interact with medications you take for Parkinson's, or may only be effective at particular doses, do not take any supplements, even vitamins, without your doctor's guidance.

Homeopathic Treatment for Parkinson’s disease:

Our experience based on about 10 cases of Parkinson’s disease (as of April 2008), is suggestive of encouraging results. At this point, we recommend homeopathy in the early cases and also those cases where the conventional treatment has either not helped at all or has helped partially. Homeopathy medicines for Parkinson’s disease provide the best supportive therapy.