Parkinson’s disease is a chronic neurological disease characterized by tremor, stiffness and slowness of movement.
Parkinson’s disease is one of the most frequent neurological diseases; it affects about 1% of the population aged between 50 and 64, and 1.5% of the population over 65. In some people, however, the disease starts earlier, immediately after a crisis of stress or without an apparent reason. Parkinson’s disease is a very gradual and insidious medical condition; it tends to start with a tremor in one hand, and then affect your movement, speech, and other functions.
Parkinson’s Disease Causes and Risk Factors
Parkinson’s disease is resulted from a decreased or loss of dopamine-producing brain cells. Dopamine is a neurotransmitter synthesized in the hypothalamus which plays an important role in the cardiovascular, renal, hormonal, and central nervous system regulation. Although cellular death in the brain is suspected, the exact cause of the disorder is not well known to scientists. There are, however, theories:
Age – age is not a causative factor of Parkinson’s disease; however, as you get older, your chance to develop the disease increases.
Genetic Factor – Parkinson’s disease is classified as a degenerative disease. Some rare cases of Parkinson’s disease are theorized to be hereditary, mostly in young patients. However, this risk factor is not known with certainty.
Toxins – it is also believed that certain toxins can result in developing Parkinsosn’s disease; however, this theory is controversial. If those toxins do not cause the disease, they are somehow triggers. Prolonged exposure to certain pesticides such as maneb and paraquat has shown to trigger symptoms similar to Parkinson’s.
Although controversial, it would be better to avoid prolonged contact to all products containing carbon monoxide and cyanide. No particular food or infectious factor has been identified in the development of Parkinson’s disease.
Head trauma – It is theorized that people who have history of head trauma are at higher risk of having Parkinson’s disease. Several researches have shown that most individuals with Parkinson’s disease had a form of head injury in the past. In fact, according to American Academy of Neurology, people who have experienced a head injury in their lives are four times more likely to develop Parkinson’s disease than those who have not.
Parkinson’s Disease Symptoms
Parkinson’s disease is a progressive medical condition; you don’t wake up one day and feel all the symptoms. You may spend months or even years with the disease without notice any obvious clinical sign. Usually, symptoms occur in one side of your body; as the disease worsens, the other or your whole body is affected. In addition, Parkinson’s disease symptoms tend to vary from one person to another; this may be due to your lifestyle or your natural body defense to the disease.
Usually, Parkinson’s disease includes four (4) primary symptoms: tremor, rigidity of the limbs, bradykinesia, and postural instability.
Tremor – at the genesis of Parkinson’s disease, you will likely have a tremor in one hand. Most often, the shaking starts in your thumb and forefinger, which typically occurs at rest and disappears during movement. The tremor can also happen during maintenance of an attitude, when you try to maintain your arms stretched before you. As the disease progresses, you may also have the trembling in your arms, legs, jaw, and face (mostly the lip or chin). No matter what organ affected, the tremor tends to disappear during sleep and increases during emotion or during effort of concentration.
Bradykinesia – usually, tremor is followed by impaired body movement. As the disease gains more control of your body, you will experience slowness of movement or difficulty to initiate your movements. When you try to walk, your steps tend to be shuffling. When you finally initiate a small step, you will have impression your feet are glued to ground. It is possible, in severe cases, to have your arms unable to swing well, your back bent forward, and your neck stiff. Startup is, paradoxically, facilitated by the presence of an obstacle. Sometimes, the blockage occurs after your first or a couple steps; you are then abruptly stopped, suddenly unable to move forward; feet freeze to the ground. Your face can also be affected; you may have difficulty in swallowing, chewing, and speaking. Your word is rare, poorly articulated, and monotonous. All actions are rare and slow.
Rigidity of the Limbs – If you have Parkinson’s disease, it is very difficult that you do not have an increased tightness in the tone of your muscle and a reduced ability to stretch them (hypertonia). From time to time or permanently, you will have a rigidity or stiffness of your limbs and axis (your neck precisely), which requires you to be more passive and more relaxed as possible. This neurologic dysfunction causes an involuntary resistance to mobilization; for instance, it may become difficult for you to do flexion-extension of your wrist. The resistance tends to disappear and reappear during movements. As the disease worsens, this rigidity tends to fix the members in the position imposed upon them.
Postural Instability – over time, Parkinson’s disease is often associated with a decreased of postural reflexes. You may also lose your balance which can cause you to fall sometimes; this occurs most often after several years of evolution of the disease.
Mental Health Disorders – psychiatric disorders are quite common in people suffereing from Parkinson’s disease. You may experience depression, anxiety, irritability, confusion, and sometimes delusions (ideas of persecution). Intellectual weakness is rare but possible. Visual hallucinations may occur, but almost always after many years of evolution or side effects of done by some treatments.
Complication of Parkinson’s symptoms may include:
- Urinary urgency
- Sexual dysfunction
- Difficulty in chewing and swallowing
- Cramps, numbness and tingling, which often associated with pain
- Digestive disorders such as constipation
- Sleep disorders such as insomnia and excessive daytime somnolence
- Excessive sweats, hot flashes, excessive salivation, etc.
Parkinson’s Disease Diagnosis
There is no specific test to diagnose Parkinson’s disease. The diagnosis is based on interrogation and physical exam. Your health care provider will look for evidence of Parkinsonian syndrome or neurologic conditions associated with the disease: tremor, bradykinesia, stiffness of muscles, postural disorders, and slow or impaired movements (difficulty of walking, speaking, writing, etc.).
Although these criteria give your doctor an idea of the disease, the diagnosis is certainly established by histological studies of the brain. In some cases, your doctor may recommend a brain scan to detect any infringement in your nervous structure. The brain scan and magnetic resonance imaging are done to rule out other diseases that may have signs and symptoms similar to Parkinson’s disease.
Parkinson’s disease diagnosis early in its evolution is not easy because the symptoms are not always present during the consultation. The diagnosis will be confirmed later by obtaining a significant relief with the symptoms at the initiation of dopaminergic treatment.
Parkinson’s Disease Treatment
Currently, there is no cure for Parkinson’s disease; no drug has demonstrated effective in eliminating completely the symptoms. There are, however, symptomatic treatments; medicaments aimed at controlling the symptoms to help you live a better life. In fact, some patients find a concrete and prolonged relief after following the treatments. Earlier the disease is discovered, better chance you have to be recovered.
Levodopa – also called L–dopa, Levodopa is a precursor of dopamine; it the favorite treatment of Parkinson’s disease treatment. The drug is very effective and generally well controls the symptoms of the disease. To prevent premature conversion to dopamine, L–dopa is often associated with carbidopa or benserazide; those drugs increase the plasma half-life of levodopa from 50 minutes to 90 minutes.
However, the effectiveness of those medications may decrease over time. In some patients, after a number of years, they may be the origin of some motor control (MC) disorders such as fluctuations effect (shift back and forth) and involuntary movements.
Dopamine agonists – dopamine agonists are substances used to supplement the deficit of dopamine; in other words, they mimic the action of dopamine in the brain. Those drugs produce less motor complications than L-Dopa; Requip (Ropinirole) and Mirapex (Pramipexole) are two medical drugs approved by the FDA in the treatment of Parkinson disease and restless legs syndrome (RLS).
However, as all drugs do, dopamine agonist medications can cause serious side effects:
- Weight gain
- Weight loss
- High blood pressure
- Dizziness, drowsiness
- Unreasonable tiredness or weakness
- Cardiac arrhythmias
- Body movements such as twitching and twisting.
Catechol O-methyltransferase (COMT) inhibitors are associated with L-Dopa to provide more continuous dopaminergic stimulation in duration. They do so by inhibiting the catechol-O-methyl transferase (COMT) enzyme, and prolonging the effects of L-dopa. COMT acts by catalyzing the degradation of catecholamines, including the neurotransmitters dopamine, epinephrine, and norepinephrine. COMT inhibitors that are used in the treatment of Parkinson disease include tolcapone and entacapone. Tolcapone, however, is no longer used in the US due to its dangerous effects on the liver. Side effects may include:
- Mood changes
- Upset stomach
- Muscle pain
- Discolored urine
- Liver damage or/and liver failure (tolcapone).
MAO B inhibitors – this class of drugs are also used in the treatment of Parkinson’s disease. They act by preventing or slowing the breakdown of dopamine in the brain. Most common MAO B inhibitors prescribed include selegiline (Eldepryl) and rasagiline (Azilect). However, selegiline is the only MAO–B inhibitor approved by the FDA. Although rare, side effect may include:
- Increased confusion.
Anticholinergics – Anticholinergic drugs are used to inhibit the action of acetylcholine, a neurotransmitter that allows the passage of nerve impulses in the synapse, the space between two neurons.
Anticholinergic drugs have some toxicity, especially among elderly patients and patients who have iridocorneal endothelial syndrome (abnormality in the inner layer of the cornea). These drugs are also dangerous in patients with enlarged prostate. Anticholinergic drugs should not be prescribed to pregnant women or women who are breastfeeding.
Surgery is barely used in the Parkinson’s disease treatment. It is only performed in severe cases of Parkinson’s or when all the medications proven to be ineffective. Deep brain stimulation is the most performed surgical intervention; however, depending on your health, your surgeon may chose to perform a pallidotomy, a procedure during which a tiny electrical probe is placed in the sub-cortical structure of your brain (globus pallidus) to destroy a small area of brain cells.
Parkinson’s Disease Alternative Treatment
Vitamin E – Many researches indicate that the mechanisms of oxidation could be involved in the onset of Parkinson’s disease. It is found less risk of the disease in subjects who consume large quantities of foods rich in vitamin E. Therefore, it is advisable for all people at risk of Parkinson’s disease or suffer from the disease to supplement their diet with antioxidants. Nevertheless, Synthetic vitamin E supplements have less or no protective effect; therefore, eat lots of foods containing vitamin E: nuts, seeds, green leafy vegetables and all other foods containing antioxidants.
Coenzyme Q10 – Coenzyme Q10 is necessary for proper cellular functioning and energy production. Studies have shown that people who suffer from Parkinson’s disease often have a deficiency of CoQ10. It is noticed that the Parkinson disease patients that take regularly coenzyme Q10 perform easier their everyday tasks. Some scientists have concluded that taking the supplement could even prevent or slow the progression of Parkinson’s disease.
Massage Therapy and Acupuncture – combination of acupuncture and Tui Na Massage can reduce the symptoms of tremor, muscle rigidity and allows regeneration of the neurons affected by the disease. In fact, acupuncture and Tui Na massage have long been used in China to treat Parkinson’s disease. The effectiveness varies from one person to another.
Alexander Technique – the Alexander technique is a psycho-physical method that applies to help the patient recognize and overcome the limitations in reactive and habitual movement and thought. In other words, this technique is used to help people with Parkinson’s disease by improving both mood and physical abilities.
Yoga and Relaxation – also called Hatha Vidya, Hatha-yoga is useful in the treatment of Parkinson’s disease; it focuses on reestablishing and maintaining the balance, relaxation and especially the relaxation of the body. Yoga and relaxation can be useful in the treatment of Parkinson’s disease as stress increases systematically the intensity of the symptoms, mainly the tremor.
1 – Bower JH, Maraganore DM, Peterson BJ, McDonnell SK, Ahlskog JE, Rocca WA (27 May 2003). “Head trauma preceding PD: a case-control study” (abstract page). Neurology 60 (10): 1610–5. PMID 12771250. http://www.neurology.org/cgi/content/abstract/60/10/1610.
2 – Costello S, Cockburn M, Bronstein J, Zhang X, Ritz B (April 2009). “Parkinson’s disease and residential exposure to maneb and paraquat from agricultural applications in the central valley of California”. Am. J. Epidemiol. 169 (8): 919–26. doi:10.1093/aje/kwp006. PMID 19270050
3 – Definition of Catechol-O-methyltransferase: MedicineNet, Inc