Parkinsonism and Parkinson’s disease

What is Parkinsonism?

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It is a clinical condition that affects movement. It is described as a syndrome because it is made up of a number of features which are always present. There are four cardinal signs of this disease noticed by the doctor. They are:

  • trembling when the hand is at rest
  • slowness of movement  or reduced movement
  • stiffness
  • unstable posture

Parkinson’s disease happens when the brain doesn’t make enough of a chemical called dopamine. This chemical is needed to send messages around the brain, and to nerves and muscles of the body. With less dopamine, one isn’t able to control their movement.

What causes it?

Parkinsonism is broadly divided into two based on its causes. There is the primary Parkinsonism, otherwise called Parkinson’s disease (PD). Its cause is not known for sure, but inherited genes are thought to play a role. By and large, the chance of getting it increases as one gets older.

The secondary (or acquired) Parkinsonism has identifiable causes such as brain infections, certain drugs, multiple brain tissue deaths from reduced oxygen supply, shocks, repeated head trauma (such as from boxing), and toxins like alcohol.

The risk of getting PD is however more in the following conditions:

  • family history of PD
  • male gender
  • head injury
  • consumption of well water
  • rural living
  • exposure to insecticides, pesticides, etc.

The chances are reduced by drinking coffee, smoking and taking drugs called non-steroidal anti-inflammatory drugs (NSAIDs).

What are the features?

Parkinson’s disease presents in four main ways. Not everyone gets all of these symptoms, and they usually start mildly before gradually progressing. They include:

Trembling at rest, worsened with emotion and certain postures. Many people rub their thumb and index finger together as if rolling a pill.

Stiff muscles usually causing a bent over posture with the limbs folded inwards.

Slow movements giving rise to reduced facial expression, serpentine stare, impaired swallowing and drooling of saliva, speech and writing problems, difficulty in rising from the bed, and shuffling gait with small steps.

Poor balance causing easy falls and walking difficulties.

No test is specific for PD, but tests are done to exclude other treatable causes of Parkinsonism.

What treatments work?

The goal of medical management is to provide control of signs and symptoms for as long as possible. There’s no cure for PD. Exercise, physiotherapy and other types of therapy can also help one cope with their symptoms.

Medicines

Medications usually provide good control of symptoms for about 4 to 6 years. After this disability usually progresses despite best medical management.

There are some drugs that slow down the loss of cells that produce dopamine. The best is Selegiline (Deprenyl), then vitamin E.

The most effective medicine for Parkinson’s symptoms is called levodopa. Levodopa is changed into dopamine in the body. It is usually combined with a medicine called carbidopa to help it work better. Other drugs which may be used are:

Dopamine agonists, such as pramipexole, ropinirole, and rotigotine. They work like dopamine in the brain.

Amantadine, which encourages the release of dopamine by the brain.

Anticholinergic drugs, such as trihexyphenidyl.

The doctor may also prescribe other medicines to help with the side effects of these treatments, or to improve the symptoms as the condition worsens.

Surgical treatment

In advanced disease, when medications are ineffective or poorly-tolerated, surgery may be the only other option. This may involve:

  • Cutting into some parts of the brain to relieve the stiffness, slow movement and trembling.
  • Deep brain stimulation using implantable electrodes positioned at various parts of the brain.
  • Transplantation of dopamine-producing cells from other sources.

Additional management includes:

  • Occupational therapy to help one find a suitable work.
  • Physical therapy to overcome some of the limitations of movement.
  • Speech therapy to improve the speech.