What is Parkinson's
Disease?
Parkinson's disease (PD) belongs to a group of conditions called
motor system disorders, which are the result of the loss of
dopamine-producing brain cells. The four primary symptoms of PD
are tremor, or trembling in hands, arms, legs, jaw, and face;
rigidity, or stiffness of the limbs and trunk; bradykinesia, or
slowness of movement; and postural instability, or impaired
balance and coordination. As these symptoms become more
pronounced, patients may have difficulty walking, talking, or
completing other simple tasks. PD usually affects people over the
age of 50. Early symptoms of PD are subtle and occur gradually. In
some people the disease progresses more quickly than in others.
As the disease progresses, the shaking, or tremor, which affects
the majority of PD patients may begin to interfere with daily
activities. Other symptoms may include depression and other
emotional changes; difficulty in swallowing, chewing, and
speaking; urinary problems or constipation; skin problems; and
sleep disruptions. There are currently no blood or laboratory
tests that have been proven to help in diagnosing sporadic PD.
Therefore the diagnosis is based on medical history and a
neurological examination. The disease can be difficult to diagnose
accurately. Doctors may sometimes request brain scans or
laboratory tests in order to rule out other diseases.
Is there any treatment?
At present, there is no cure for PD, but a variety of medications
provide dramatic relief from the symptoms. Usually, patients are
given levodopa combined with carbidopa. Carbidopa delays the
conversion of levodopa into dopamine until it reaches the brain.
Nerve cells can use levodopa to make dopamine and replenish the
brain's dwindling supply. Although levodopa helps at least
three-quarters of parkinsonian cases, not all symptoms respond
equally to the drug. Bradykinesia and rigidity respond best, while
tremor may be only marginally reduced. Problems with balance and
other symptoms may not be alleviated at all. Anticholinergics may
help control tremor and rigidity. Other drugs, such as
bromocriptine, pramipexole, and ropinirole, mimic the role of
dopamine in the brain, causing the neurons to react as they would
to dopamine. An antiviral drug, amantadine, also appears to reduce
symptoms.
In some cases, surgery may be appropriate if the disease doesn't
respond to drugs. A therapy called deep brain stimulation (DBS)
has now been approved by the U.S. Food and Drug Administration. In
DBS, electrodes are implanted into the brain and connected to a
small electrical device called a pulse generator that can be
externally programmed. DBS can reduce the need for levodopa and
related drugs, which in turn decreases the involuntary movements
called dyskinesias that are a common side effect of levodopa. It
also helps to alleviate fluctuations of symptoms and to reduce
tremors, slowness of movements, and gait problems. DBS requires
careful programming of the stimulator device in order to work
correctly.
What is the prognosis?
PD is both chronic, meaning it persists over a long period of
time, and progressive, meaning its symptoms grow worse over time.
Although some people become severely disabled, others experience
only minor motor disruptions. Tremor is the major symptom for some
patients, while for others tremor is only a minor complaint and
other symptoms are more troublesome. No one can predict which
symptoms will affect an individual patient, and the intensity of
the symptoms also varies from person to person.
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