PARKINSON'S BASICS
Parkinson’s disease is a degenerative disease of the nervous system that progresses slowly over time. The disease is caused when there is a loss of nerve cells in a part of the brain called the substantia nigra. The substantia nigra is located in the mid-brain and is part of a larger brain structure called the basal ganglia. These particular cells are responsible for producing a chemical called dopamine, which sends messages to different parts of the brain to help coordinate and smooth out muscle and body movement. A large amount of these cells degenerate and no longer produce dopamine. Therefore without enough dopamine production, the brain has a more difficult time coordinating movement.
There are four common symptoms of Parkinson’s:
- Tremor in hands, arms, legs, jaw and face;
- Weak limb or slowness in movement;
- Stiff or Rigid limb;
- Gait Disorder or postural instability.
It’s very important not to confuse these symptoms from similar but different diagnoses such and Essential Tremors which occur during action unlike the Tremors of Parkinson’s which occur at rest, as well as other musculoskeletal syndromes and disorders. Parkinson’s is misdiagnosed 25% of the time because of these types of confusions.
Up to date, there are no lab tests that can confirm Parkinson’s. A diagnosis is made by a careful medical history and by ruling out all other conditions. Lab tests are very useful in ruling out these other disorders and conditions. Once a diagnosis has been made, there are several ways to manage the disease.
The early stages of the disease are subtle and the development of the disease is most often very gradual. Because of this, one has much more time to educate oneself about the disease before deciding which road to take in terms of treatment and disease management. The more one understands the nature of the disease, the more one adapt to and create a more comfortable lifestyle.
For a patient in the early stages of the Parkinson’s or with symptoms that are not bothersome it is considered very reasonable to postponed drug therapy treatment. One should consult with one’s doctor about different options such as exercise, movement therapy, massage, and diet. These are known to enhance and improve daily activities and many times help relax symptoms.
“Drug Therapy is warranted when the patient is sufficiently bothered by symptoms to desire treatment or when the disease is producing disability.” (1) A patient’s desires are a critical part in decisions made with one’s doctor. Levodopa and dopamine agonists are the most common drug therapies given for initial treatment to treat motor symptoms. These drugs have been shown to improve motor symptoms from 30%-50%.
When there is no response to drug therapy there are options of surgical therapy such as Thalamotomy and thalamic stimulation, which can be helpful in treating the tremor of Parkinson’s and the Pallidotomy, pallidal deep brain stimulation and sub-thalamic deep-brain stimulation which can help improve all symptoms of Parkinson’s. Surgery is usually indicated only in later stages of the disease because of risk and cost factors.
Internet Sources
Parkinson’s Disease Society of the
http://www.parkinsons.org.uk/PDF/nerves.pdf
Medical Journal Source
(1) John G. Nutt, M.D., and G. Frederick Wooten, M.D., “Diagnosis and Initial Management of Parkinson’s Disease”, The New England Journal of Medicine – September 8, 2005
Medical Book Source
The Merck Manual of Medical Information 2nd Edition,
a division of Simon & Schuster, 2004, 546-550