What is Parkinson disease?
Parkinson’s Disease (PD) is a degenerative brain disorder that affects movements such as walking, writing, and talking. It occurs when nerve cells that are located in a part of the midbrain called the substantia nigra die or get damaged. When this happens, the neurons stop producing a hormone called dopamine. One of dopamine’s tasks in the body is to help the muscles move smoothly, and in a coordinated manner. When about 80% of the cells that produce dopamine are damaged, not enough dopamine is produced and a person starts to exhibit.
The classic signs of Parkinson’s Disease are:
The loss of dopamine production in the brain causes the primary symptoms of Parkinson disease.
* slowed movements
* lack of balance
Some patients exhibit these additional symptoms:
* shuffling walk
* muffled speech
* stiff facial expression
* small, cramped handwriting
Who gets Parkinson’s Disease?
Parkinson’s disease is found in equal numbers in both men and women. It affects every ethnic group and nationality. One and a half million Americans currently suffer from Parkinson’s disease. Approximately 60,000 new cases of Parkinson’s disease are diagnosed each year. In most cases, the disease develops after the age of 65, however 15% of those diagnosed are under 50.
There is currently no clinical test for Parkinson’s. This can make the process of diagnosing Parkinson’s disease a long and difficult one. Various tests, such as blood tests and MRI brain scans are usually performed to rule out other conditions that present with similar symptoms. If Parkinson’s is suspected, you should seek the care of a neurologist who specializes in Parkinson’s disease.
People with mild symptoms of Parkinson’s might not need any treatment in the early stages of the disease. As symptoms progress, patients may be offered some of the following treatments.
Choice of medication must be suited to the individual and his or her condition. Your doctor will take into consideration such things as the severity of symptoms, your age and the presence of other medical conditions. Response to medication is very individual, so it may take some time to get the medication and dosage right. As your Parkinson’s progresses, dosages may need to be adjusted. In certain cases, a combination of drugs is prescribed. It is important to receive care from a doctor who has extensive experience treating Parkinson’s disease in all its stages.
The first medicine prescribed is usually Levodopa. Levodopa is a substance that is naturally found in the body in small amounts. Once Levodopa is in the system, the body converts it into dopamine, a hormone that is lacking in Parkinson’s patients.
Dopamine agonists, another class of drugs, were introduced 20 years ago to help minimize symptoms. It can be used on its own or together with levodopa. Agonists are chemicals that can combine with part of a cell and initiating a reaction or activity.
A new class of medication for Parkinson’s, COMT inhibitors, was approved by the Food and Drug Administration in 1998. COMT inhibitors work by blocking an enzyme that breaks down levodopa. COMT inhibitors prolong the effectiveness of levodopa therapy.
There are a number of surgical options available to severely affected patients: ablation, deep brain stimulation, and pallidotomy.
Ablation is the process of pinpointing and ablating (destroying) the area of the brain affected by Parkinson’s. The tissue that produces abnormal chemical or electrical impulses causing abnormal movements is destroyed. This procedure is performed less frequently than deep brain stimulation.
Deep Brain Stimulation (DBS)
DBS targets and inactivates specified areas in the brain where uncontrolled movements originate. The area is inactivated (not destroyed) by an implanted electrode. The electrode in the brain is connected to a stimulator and battery pack in the patient’s chest through a wire that runs beneath the skin.
Pallidotomy is a delicate surgical operation that targets a part of the brain called the pallidum that controls certain symptoms. During the procedure, a delicate probe measures abnormal electrical activity. A second probe delivers small electrical shocks. The patient, who is conscious during the surgery, provides the surgeon with feedback on the effects of the probe. Having pinpointed the region responsible for controlling certain movement, the surgeon burns a minute hole in the cells. The results can be felt almost immediately.
In this form of treatment, cell that produce dopamine are implanted directly into the brain. These cells may come from embryonic stem cells or from fetal cells.
In addition to medication and surgical options, other therapies and nutritional supplements may provide symptomatic relief and improve the patient’s quality of life. Physical therapy has been shown to strengthen and tone muscles and help increase the range of motion. In addition to building muscle strength, physical therapy improves balance, helps overcome gait problems, and improves swallowing and speaking. Everyday activities such as walking, gardening and swimming can also improve patient’s sense of well-being. For some, massage may afford much needed relief from muscle rigidity as well as providing other neuromuscular benefits.